Organizational Antecedents to the Implementation of Precision Medicine: Overcoming Resistance to Change

Abstract

Precision medicine (PM) is “the treatment and prevention of disease that takes into account individual variability in genes, environment, and lifestyle for each person” (NIH, 2015). PM was poised to transform clinical practice in 2003 when the Human Genome Project reached completion but resistance to implementation at virtually all health care providers provides the basis for novel study on the diffusion of innovation as well as operational strategy. Existing studies on resistance to PM explore the role of reimbursement, economics, regulatory affairs, and public policies. Investigation into the antecedent conditions for implementation at the physician and organizational levels has been overlooked, a gap this study fills. The research captures the reasons for resistance at the physician and organizational levels and identifies operational strategies for successful implementation at three health care institutions with fully integrated PM programs. The research produced 42 findings with managerial implications and six testable propositions for future research. The dynamics of resistance to PM has revealed key implications for theories of organizational change. These include the observation that the formulation processes of clinical standards of practice in PM are not predicted by prevailing organizational theory; that conventional theories of resistance to change do not fully anticipate the effects of Kuhnian level historic paradigm shifts; and, that communities of practice play a critical role in transformational clinical change. Further, the research demonstrated that PM implementation is characterizable through reproducible organizational and cultural actions; that positive clinical outcomes are measurable and persuasive; and that the needs of stakeholders can be reconciled by aligning physician standards of practice with patient expectations and organizational needs.